Skip to main content
SpringerLink
Log in

Impact of the Reconstruction Method on Delayed Gastric Emptying After Pylorus-Preserving Pancreaticoduodenectomy: A Prospective Randomized Study

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Delayed gastric emptying (DGE) is of considerable concern in patients undergoing pylorus-preserving pancreaticoduodenectomy (PPPD). Prolonged hospital stay, increased cost, and decreased quality of life add on to interventions needed to treat DGE. This study was conducted to determine if performing duodenojejunostomy via the antecolic rather than the retrocolic route improved incidence of DGE.

Methods

Patients undergoing PPPD between April 2007 and November 2009 were randomized for either antecolic or retrocolic reconstruction of the duodenojejunostomy. DGE was then assessed by clinical criteria on postoperative day (POD) 10. A paracetamol absorption test was also administered with a liquid meal, and serial plasma levels of intestinal peptides were measured.

Results

Overall, 64 patients were amenable for analysis: 36 in the antecolic group and 28 in the retrocolic group. The incidences of DGE on POD 10 were 17.6 and 23.1 % (antecolic vs. retrocolic, respectively) (p = 0.628). The two groups did not differ in regard to their median (interquartile range) postoperative hospital length of stay [13.0 (10.0–17.5) vs. 12.5 (11.0–17.0) days; p = 0.446], time to regular diet [5 (5–7) vs. 5 (4–6) days; p = 0.353], or morbidity (52.9 vs. 50.0 %; p = 0.777). The median length of nasogastric tube decompression was similar in the two groups [4 (3–7) vs. 3 (3–5) days; p = 0.600]. Levels of paracetamol and glucagon-like peptide-1 were markedly decreased in patients with DGE.

Conclusions

Antecolic reconstruction after PPPD does not improve the occurrence/the incidence of DGE and is similar to retrocolic reconstruction with regard to secondary outcome parameters.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Whipple AO, Parsons WB, Mullins CR (1935) Treatment of carcinoma of the ampulla of Vater. Ann Surg 102:763–779

    Article  CAS  PubMed  Google Scholar 

  2. Traverso LW, Longmire WP Jr (1978) Preservation of the pylorus in pancreaticoduodenectomy. Surg Gynecol Obstet 146:959–962

    CAS  PubMed  Google Scholar 

  3. Tran KT, Smeenk HG, van Eijck CH et al (2004) Pylorus preserving pancreaticoduodenectomy versus standard Whipple procedure: a prospective, randomized, multicenter analysis of 170 patients with pancreatic and periampullary tumors. Ann Surg 240:738–745

    Article  PubMed  Google Scholar 

  4. Diener MK, Knaebel HP, Heukaufer C et al (2007) A systematic review and meta-analysis of pylorus-preserving versus classical pancreaticoduodenectomy for surgical treatment of periampullary and pancreatic carcinoma. Ann Surg 245:187–200

    Article  PubMed  Google Scholar 

  5. Hartel M, Wente MN, Hinz U et al (2005) Effect of antecolic reconstruction on delayed gastric emptying after the pylorus-preserving Whipple procedure. Arch Surg 140:1094–1099

    Article  PubMed  Google Scholar 

  6. Tani M, Terasawa H, Kawai M et al (2006) Improvement of delayed gastric emptying in pylorus-preserving pancreaticoduodenectomy: results of a prospective, randomized, controlled trial. Ann Surg 243:316–320

    Article  PubMed  Google Scholar 

  7. Sugiyama M, Abe N, Ueki H et al (2004) A new reconstruction method for preventing delayed gastric emptying after pylorus-preserving pancreatoduodenectomy. Am J Surg 187:743–746

    Article  PubMed  Google Scholar 

  8. Murakami Y, Uemura K, Sudo T et al (2008) An antecolic Roux-en-Y type reconstruction decreased delayed gastric emptying after pylorus-preserving pancreatoduodenectomy. J Gastrointest Surg 12:1081–1086

    Article  PubMed  Google Scholar 

  9. Horstmann O, Becker H, Post S et al (1999) Is delayed gastric emptying following pancreaticoduodenectomy related to pylorus preservation? Langenbecks Arch Surg 384:354–359

    Article  CAS  PubMed  Google Scholar 

  10. DeOliveira ML, Winter JM, Schafer M et al (2006) Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg 244:931–937 discussion 937–939

    Article  PubMed  Google Scholar 

  11. Wente MN, Bassi C, Dervenis C et al (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 142:761–768

    Article  PubMed  Google Scholar 

  12. Nguyen TC, Sohn TA, Cameron JL et al (2003) Standard vs. radical pancreaticoduodenectomy for periampullary adenocarcinoma: a prospective, randomized trial evaluating quality of life in pancreaticoduodenectomy survivors. J Gastrointest Surg 7:1–9 discussion 9–11

    Article  PubMed  Google Scholar 

  13. Yeo CJ, Barry MK, Sauter PK et al (1993) Erythromycin accelerates gastric emptying after pancreaticoduodenectomy: a prospective, randomized, placebo-controlled trial. Ann Surg 218:229–237 discussion 237–228

    Article  CAS  PubMed  Google Scholar 

  14. Bassi C, Falconi M, Molinari E et al (2005) Reconstruction by pancreaticojejunostomy versus pancreaticogastrostomy following pancreatectomy: results of a comparative study. Ann Surg 242:767–771 discussion 771–763

    Article  PubMed  Google Scholar 

  15. Gangavatiker R, Pal S, Javed A et al (2011) Effect of antecolic or retrocolic reconstruction of the gastro/duodenojejunostomy on delayed gastric emptying after pancreaticoduodenectomy: a randomized controlled trial. J Gastrointest Surg 15:843–852

    Article  PubMed  Google Scholar 

  16. Heading RC, Nimmo J, Prescott LF et al (1973) The dependence of paracetamol absorption on the rate of gastric emptying. Br J Pharmacol 47:415–421

    Article  CAS  PubMed  Google Scholar 

  17. Medhus AW, Sandstad O, Bredesen J et al (1999) Delay of gastric emptying by duodenal intubation: sensitive measurement of gastric emptying by the paracetamol absorption test. Aliment Pharmacol Ther 13:609–620

    Article  CAS  PubMed  Google Scholar 

  18. Morioka J, Miyachi M, Niwa M et al (2008) Gastric emptying for liquids and solids after distal gastrectomy with Billroth-I reconstruction. Hepatogastroenterology 55:1136–1139

    PubMed  Google Scholar 

  19. Strommer L, Raty S, Hennig R et al (2005) Delayed gastric emptying and intestinal hormones following pancreatoduodenectomy. Pancreatology 5:537–544

    Article  PubMed  Google Scholar 

  20. Schirra J, Katschinski M, Weidmann C et al (1996) Gastric emptying and release of incretin hormones after glucose ingestion in humans. J Clin Invest 97:92–103

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Yamamoto H, Mori T, Tsuchihashi H et al (2005) A possible role of GLP-1 in the pathophysiology of early dumping syndrome. Dig Dis Sci 50:2263–2267

    Article  CAS  PubMed  Google Scholar 

  22. Ballantyne GH (2006) Peptide YY(1–36) and peptide YY(3–36). Part I. Distribution, release and actions. Obes Surg 16:651–658

    Article  PubMed  Google Scholar 

  23. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6,336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  Google Scholar 

  24. Rumack BH, Matthew H (1975) Acetaminophen poisoning and toxicity. Pediatrics 55:871–876

    CAS  PubMed  Google Scholar 

  25. Miholic J, Hoffmann M, Holst JJ et al (2007) Gastric emptying of glucose solution and associated plasma concentrations of GLP-1, GIP, and PYY before and after fundoplication. Surg Endosc 21:309–314

    Article  CAS  PubMed  Google Scholar 

  26. Lavu H, Kennedy EP, Mazo R et al (2010) Preoperative mechanical bowel preparation does not offer a benefit for patients who undergo pancreaticoduodenectomy. Surgery 148:278–284

    Article  PubMed  Google Scholar 

  27. Baggio LL, Drucker DJ (2007) Biology of incretins: GLP-1 and GIP. Gastroenterology 132:2131–2157

    Article  CAS  PubMed  Google Scholar 

  28. Blom WA, Lluch A, Vinoy S et al (2006) Effects of gastric emptying on the postprandial ghrelin response. Am J Physiol Endocrinol Metab 290:E389–E395

    Article  CAS  PubMed  Google Scholar 

  29. Malleo G, Crippa S, Butturini G et al (2010) Delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy: validation of International Study Group of Pancreatic Surgery classification and analysis of risk factors. HPB (Oxford) 12:610–618

    Article  Google Scholar 

  30. Welsch T, Borm M, Degrate L et al (2010) Evaluation of the International Study Group of Pancreatic Surgery definition of delayed gastric emptying after pancreatoduodenectomy in a high-volume centre. Br J Surg 97:1043–1050

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

The authors do not disclose any potential conflict of interest.

Author information

Authors and Affiliations

  1. Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 10990, Vienna, Austria

    Dietmar Tamandl, Klaus Sahora, Johannes Prucker, Johannes Miholic, Peter Goetzinger & Michael Gnant

  2. Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, Vienna, Austria

    Rainer Schmid

  3. Department of Biomedical Sciences, The Panum Institute, University of Copenhagen, Copenhagen, Denmark

    Jens-Juul Holst

Authors
  1. Dietmar Tamandl
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Klaus Sahora
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Johannes Prucker
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rainer Schmid
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jens-Juul Holst
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Johannes Miholic
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Peter Goetzinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Michael Gnant
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dietmar Tamandl.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tamandl, D., Sahora, K., Prucker, J. et al. Impact of the Reconstruction Method on Delayed Gastric Emptying After Pylorus-Preserving Pancreaticoduodenectomy: A Prospective Randomized Study. World J Surg 38, 465–475 (2014). https://doi.org/10.1007/s00268-013-2274-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-013-2274-4

Keywords

Search

Navigation